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Health Bucks

Implementation

How It Works: The New York City Health Bucks program has grown rapidly. This section of the template describes how the program is currently implemented 

Role of the NYC Department of Health and Mental Hygiene (Department of Health):

  • The Department of Health manages, implements, and arranges for the funding of the Health Bucks Program. During the pilot years, the program was funded entirely by the Health Department. As the program grew to incorporate a SNAP-use incentive, funding streams from the New York City Human Resources Administration, which administers the SNAP program, were added.

Role of the NYC Department of Health, Food Access and Community Health Program (formerly the Physical Activity and Nutrition (PAN) Program:
The Food Access and Community Health Program manages and coordinates the Health Bucks Program with the local District Public Health Offices in the South Bronx, East and Central Harlem and Central Brooklyn. PAN’s responsibilities are to:

  • Coordinate all central aspects of the Health Bucks program including financing, budgeting, developing application materials, Health Bucks tracking, invoicing, report development, and technical assistance.
  • Print Health Bucks—each Health Buck is printed with a unique bar code for tracking.  The bar codes allow for tracking of redeemed coupons based on which community-based organization or farmers’ market gave the Health Buck to a consumer.  As of 2009, these bar codes can be scanned electronically instead of counted numerically. (In the beginning, NYC stamped each Health Buck with a serial number to allow for tracking and monitoring.)
  • Develop, print and distribute promotional flyers, posters and maps of all participating farmers’ markets, including a description of the Health Bucks program and its relationship with EBT.
  • Maintain the Health Bucks web site.
  • Conduct marketing, including press releases.
  • Oversee the outreach and implementation efforts of the District Public Health Offices.
  • Operate the Stellar Farmers’ Market initiative that sponsors free nutrition workshops and cooking demonstrations at select markets. This initiative promotes the benefits of a diet rich in fruits and vegetables and improves the ability of New Yorkers to prepare healthy meals using locally grown, seasonal produce. Using the Just Say Yes to Fruits and Vegetables curriculum, Stellar Farmers’ Market nutritionists use produce purchased at the market that day to teach healthy eating, food resource management, food safety and tips on saving money when food shopping. Information on Health Bucks and the EBT incentive is presented at every workshop.

Role of Health Bucks Program Manager at each District Public Health Office:
Health Bucks program managers coordinate much of the physical activity and nutrition programming for the District Offices. Coordinating Health Bucks distribution is one of their many tasks. They have responsibilities before and during the market season:

  • Approve applications from community-based organizations (CBOs) to distribute Health Bucks.
  • Identify potential participating markets and train workers in those markets in Health Bucks mechanics.
  • Distribute Health Bucks to community groups and farmers’ markets and encourage their use with EBT benefits at farmers’ markets.
  • Visit farmers’ markets to ensure compliance with Health Bucks protocol.
  • Distribute promotional materials including flyers, posters, maps and banners.
  • Coordinate a promotional “kickoff” event at the beginning of the season event to support community groups and farmers’ markets in adhering to Health Bucks protocol.
  • Maintain accurate tracking records of all Health Bucks distributed and submit to the Food Access and Community Health Program staff.

Role of Farmers’ Market Operators and Managers:

  • If a market accepts EBT, they also generally employ a market manager to run the EBT machine. Farmers’ market managers operate the EBT terminals, swipe EBT cards, distribute Health Bucks to eligible consumers and keep track of every Health Buck distributed.
  • Market managers post relevant information about Health Bucks and EBT at their stations and are trained on how to promote EBT use and to answer questions.
  • Market managers receive free promotional materials including banners, posters and aprons to ensure customers are aware of the Health Bucks incentive.
  • Market operators (people who may not work at the market but oversee its function) and/or the market managers attend an annual meeting and provide EBT data from their markets.

Role of Local Farmers:

  • Local farmers are invited to participate in the Health Bucks program and receive information about how it works.
  • Participating farmers redeem their Health Bucks from a contractor (Farmers Market Federation of New York), which sends them a check for the value of their submitted coupons.  To track their coupons, farmers stamp each Health Buck with their identification number.

Role of The Farmers Market Federation of New York (FMFNY):
FMFNY is a grassroots, membership organization of farmers’ market managers, market sponsors, farmers and market supporters. The role of the FMFNY is to:

  • Administer the Health Bucks redemption to farmers. Farmers submit their Health Bucks to the FMFNY, which is responsible for tracking, accounting and cutting checks to farmers. In 2009, bar codes replaced serial numbers on the coupons, allowing scanning to replace manual coupon verification. Coupons are electronically scanned, allowing each coupon to be recorded in a farmer’s individual spreadsheet.  Payment reaches farmers in 2-3 days.
  • Promote the Health Bucks program to farmers and recruit them to join the program.
  • Educate participating farmers about how the program works and how to redeem Health Bucks for money. The growing number of nutrition programs to assist low-income consumers can overwhelm farmers. The FMFNY, with the assistance of the New York State Department of Agriculture, created a laminated instruction card highlighting the details of accepting and redeeming script from each of the different nutrition programs. The instruction card is distributed to each farmer participating in EBT, USDA Farmers’ Market Nutrition Programs (FMNP) and the WIC Vegetable and Fruit Check Program. Each farmer participating in the Health Bucks program is given a detailed instruction sheet highlighting the differences between accepting and redeeming Health Bucks and coupons from FMNP.
  • Track redemption rates per farmer, market and community site using spreadsheets provided by the Department of Health.

Role of Community Partners:

  • The DPHOs distribute Health Bucks to approved community-based organizations (CBOs), which, in turn, distribute the coupons to community residents to encourage them to shop at their local farmers’ market.  Approved CBOs and sites include churches, schools, youth centers, WIC centers, federally funded clinics, and afterschool and daycare programs. Community organizations located in neighborhoods served by the DPHOs receive priority to apply for Health Bucks to distribute to their constituents. In their applications, CBOs must indicate how they will incorporate educational information about the benefits of increasing produce consumption into their Health Bucks distribution plan.
  • Many organizations, including the Department of Health’s Stellar Farmers’ Market initiative (see above) and Cooperative Extension, provide nutrition education and cooking demonstrations at the market itself using fresh market produce to educate shoppers about how to use the fruits and vegetables they purchase. Cooking demonstrations encourage shoppers to try new foods and increase sales at the markets. Nutrition education classes can include information about portion sizes, the food pyramid, proper food storage and safety.  Educating people on proper use and storage of fresh foods is particularly important if they use EBT and are at greater risk of using all of their food stamp benefits before the end of the month.
  • Some SNAP programs (e.g. SNAP enrollment offices) distribute Health Bucks to their recipients.
  • Some WIC programs give Health Bucks to parents, and, by engaging mothers, encourage more fruits and vegetables in children’s diets. 

Keys to Success

  • Increase the number of markets that can accept EBT.
  • Health Bucks handed directly to customers at the markets encourage EBT use, which results in Health Bucks being used immediately and in high redemption rates and farmer profit. In addition, having Health Bucks as an incentive for EBT use has tremendously increased EBT sales at markets.
  • The new electronic bar code system, which replaced inputting by hand, has reduced from days to hours the time taken to prepare per farmer accounts.  Scanning bar codes on Health Bucks accelerates coupon verification, allowing reimbursement checks to be sent to farmers within 2-3 days of the Health Bucks being received.
  • The color of the Health Buck coupon should be changed each year. This helps farmers recognize the current year coupon without having to search for a date. This is important in a fast-paced marketplace.  To track coupons to individual farmers, each farmer stamps his/her identification number in a box on the Health Buck.
  • Promotions using the coupon image in an ad should print “VOID” across the coupon to eliminate the possibility of fraud.
  • Maps showing locations of farmers’ markets, including information on the incentive program, help direct customers to nearby markets.
  • Send mailings to SNAP recipients informing them about the Health Buck incentive.
  • Marketing materials promoting the Health Bucks incentive should be visible at all participating markets.
  • To assist farmers, develop and distribute a laminated instruction card highlighting the details of accepting and redeeming coupons from the various nutrition assistance programs. For more details, see Role of FMF above.
  • Nutrition workshops and cooking demonstrations help SNAP recipients try new foods and recipes. Farmers reported increased sales — and some even sold out of the produce featured in the workshops.

Barriers to Implementation

  • Getting EBT into farmers’ markets can be financially challenging.
  • As the Health Bucks program grows in popularity, identifying a stable source of funding can be difficult. The demand for Health Bucks is endless; funds are limited.
  • As the program expands, distributing and tracking Health Bucks becomes more time intensive.